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POSTED ON KROLL MAP NO.: PERMIT
DEPARTMENT NUMBER 680416
BUILDING Applicant Fill
77513 ADDRESS
PERMIT APPLICATION inside Heavy Lines S
NAME,AUP NAME OF BUSINESS)
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TELEPHONN NUMBER
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ADDRESS
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REMARKS
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DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
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PRE -MOVE
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POOL
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I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation Of the Labor Code of the State Of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This permIt coven work to be done on private Property ONLY.
Any construction on the public domain (earbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WA.LL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ITOTAL AMOUNT DUE
ATTENTION
THIS PERIMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
DEFICIENCY THIS PROPERTY
[] YES 0 NO
Valuation I Fee
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APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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